| Immunization admin first vaccine component CPT 90460 • Preventive Care | $14 | $17 | $18 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $8 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $7 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $197 | $282 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $271 | $278 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $21 | $68 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $18 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $54 | $92 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $27 | $47 |
| Varicella vaccine CPT 90716 • Preventive Care | $29 | $106 | $182 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $76 | $132 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $126 | $205 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $91 | $135 | $178 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $65 | $126 | $187 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $18 | $65 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $66 | $97 | $128 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $92 | $108 | $124 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $22 | $135 | $247 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $20 | $74 | $128 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $41 | $101 | $161 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $55 | $99 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $30 | $56 | $81 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $8 | $70 | $113 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $17 | $43 | $69 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $9 | $42 | $75 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $20 | $120 | $221 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $17 | $31 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $27 | $61 | $92 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $175 | $232 | $289 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $38 | $175 | $311 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $109 | $109 | $110 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $110 | $151 | $186 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $93 | $107 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $76 | $234 | $393 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $23 | $230 | $437 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $220 | $220 | $221 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $44 | $184 | $323 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $19 | $247 | $440 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $24 | $491 | $959 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $109 | $150 |
| Spirometry CPT 94010 • Pulmonology | $8 | $14 | $19 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $9 | $24 | $40 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $23 | $32 | $41 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $25 | $39 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $90 | $173 | $256 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $10 | $15 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $30 | $44 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $13 | $27 | $41 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $33 | $40 | $50 |